Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A106075 | CA |
Y | 111NI0900X | Internist | A106075 | CA |
NPI | 1003043712 |
---|---|
Provider Name | Igor Gorokhov |
First Address | Canoga Park, CA 91309-0522 |
Second Address | Beverly Hills, CA 90210-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2009 |
Last Update Date | 08/12/2013 |